scholarly journals Demographic and Socio-Economic Factors, and Healthcare Resource Indicators Associated with the Rapid Spread of COVID-19 in Northern Italy: An Ecological Study

2020 ◽  
Author(s):  
Alessandra Buja ◽  
Matteo Paganini ◽  
Silvia Cocchio ◽  
Manuela Scioni ◽  
Vincenzo Rebba ◽  
...  
Keyword(s):  
Public Transportation ◽  
Ecological Study ◽  
Acute Care Hospital ◽  
Northern Italy ◽  
P Value ◽  
Care Hospital ◽  
Term Care ◽  
Significant Difference ◽  
Hospital Beds ◽  
Province Level

ABSTRACTBackgroundCOVID-19 rapidly escalated into a pandemic, threatening 213 countries, areas, and territories the world over. We aimed to identify potential province-level socioeconomic determinants of the virus’s dissemination, and explain between-province differences in the speed of its spread, based on data from 36 provinces of Northern Italy.MethodsThis is an ecological study. We included all confirmed cases of SARS-CoV-2 reported between February 24th and March 30th, 2020. For each province, we calculated the trend of contagion as the relative increase in the number of individuals infected between two time endpoints, assuming an exponential growth. Pearson’s test was used to correlate the trend of contagion with a set of healthcare-associated, economic, and demographic parameters by province. The virus’s spread was input as a dependent variable in a stepwise OLS regression model to test the association between rate of spread and province-level indicators.FindingsMultivariate analysis showed that the spread of COVID-19 was correlated negatively with aging index (p-value=0.003), and positively with public transportation per capita (p-value=0.012), the % of private long-term care hospital beds and, to a lesser extent (p-value=0.070), the % of private acute care hospital beds (p-value=0.006).InterpretationDemographic and socioeconomic factors, and healthcare organization variables were found associated with a significant difference in the rate of COVID-19 spread in 36 provinces of Northern Italy. An aging population seemed to naturally contain social contacts. The availability of healthcare resources and their coordination could play an important part in spreading infection.

scholarly journals Demographic and socio-economic factors, and healthcare resource indicators associated with the rapid spread of COVID-19 in Northern Italy: An ecological study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244535
Author(s):  
Alessandra Buja ◽  
Matteo Paganini ◽  
Silvia Cocchio ◽  
Manuela Scioni ◽  
Vincenzo Rebba ◽  
...  
Keyword(s):  
Public Transportation ◽  
Ecological Study ◽  
Acute Care Hospital ◽  
Northern Italy ◽  
P Value ◽  
Care Hospital ◽  
Term Care ◽  
Significant Difference ◽  
Hospital Beds ◽  
Province Level

Background COVID-19 rapidly escalated into a pandemic, threatening 213 countries, areas, and territories the world over. We aimed to identify potential province-level socioeconomic determinants of the virus’s dissemination, and explain between-province differences in the speed of its spread, based on data from 36 provinces of Northern Italy. Methods This is an ecological study. We included all confirmed cases of SARS-CoV-2 reported between February 24th and March 30th, 2020. For each province, we calculated the trend of contagion as the relative increase in the number of individuals infected between two time endpoints, assuming an exponential growth. Pearson’s test was used to correlate the trend of contagion with a set of healthcare-associated, economic, and demographic parameters by province. The virus’s spread was input as a dependent variable in a stepwise OLS regression model to test the association between rate of spread and province-level indicators. Results Multivariate analysis showed that the spread of COVID-19 was correlated negatively with aging index (p-value = 0.003), and positively with public transportation per capita (p-value = 0.012), the % of private long-term care hospital beds and, to a lesser extent (p-value = 0.070), the % of private acute care hospital beds (p-value = 0.006). Conclusion Demographic and socioeconomic factors, and healthcare organization variables were found associated with a significant difference in the rate of COVID-19 spread in 36 provinces of Northern Italy. An aging population seemed to naturally contain social contacts. The availability of healthcare resources and their coordination could play an important part in spreading infection.

scholarly journals 2849. Gut Microbiota Differences at the Time of Medical Intensive Care Unit (MICU) Admission Are Associated with Acquisition of Multi-drug-Resistant Organisms (MDROs) Among Patients Not Already Colonized with an MDRO

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S71-S72
Author(s):  
Christine Bassis ◽  
Anna Seekatz ◽  
Thelma E Dangana ◽  
Teppei Shimasaki ◽  
Rachel D Yelin ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Acute Care Hospital ◽  
Wilcoxon Test ◽  
Sequence Difference ◽  
P Value ◽  
Rrna Gene ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Operational Taxonomic Units ◽  
Significant Difference

Abstract Background Among hospitalized patients, underlying variation in gut microbiota may confer differential risk for gut MDRO acquisition. Methods Rectal swab samples were collected from patients ≤2 days of MICU admission and then daily in the 27-bed MICU of an acute care hospital in Chicago, IL over 1 year. Patients were screened for MDRO colonization by selective culture (see Figure 1 for MDRO types); those with ≥2 swabs and MICU stays ≥3 days were studied. Bacterial 16S rRNA gene amplicon sequences were used for microbiota analysis. Medical records were reviewed. Results In preliminary analysis, 2,480 samples were collected from 627 patients who acquired 170 MDROs (Figure 1). Debilitation, co-morbidities, and certain medical devices were associated with MDRO acquisition, though admission MDRO status was not (table). While no interactions were detected between admission MDRO status and clinical predictors of MDRO acquisition, there were significant differences in gut microbiota composition at the time of MICU admission between patients colonized with an MDRO on admission and those not colonized (P < 0.001, using analysis of molecular variance (AMOVA) on distances). Therefore, we stratified our analysis by admission MDRO colonization status. For patients MDRO-colonized at admission, there were no significant differences in microbiota of patients who later did or did not acquire a new MDRO (AMOVA P-value = 0.32). For patients not MDRO-colonized on admission, there was a significant difference in microbiota of patients who later acquired an MDRO and those who did not (AMOVA P-value: 0.026). Differentially abundant operational taxonomic units (OTUs, based on 3% sequence difference) included OTUs classified as Anaerococcus and as other Clostridiales (higher in patients who remained uncolonized) and as Enterococcus (higher in patients who acquired an MDRO) (Figure 2). Diversity was also higher in patients who remained uncolonized (Wilcoxon test P-value: 0.035) (Figure 3). Conclusion Among patients not already colonized with an MDRO on admission, we identified gut microbiota differences associated with MDRO acquisition that could help explain patient-level variation in MDRO colonization resistance. Disclosures All Authors: No reported Disclosures.

scholarly journals Suction catheter usage and cost at long-term care hospitals in Republic of Korea

2021 ◽  
Vol 10 (1) ◽  
pp. 1
Author(s):  
Kyung Hun Nam ◽  
Dae Hyun Kim ◽  
Won Ki Baek ◽  
Han Byul Lee ◽  
Joo Hyung Kim
Keyword(s):  
Long Term Care ◽  
Financial Burden ◽  
Suction Catheter ◽  
P Value ◽  
Care Hospital ◽  
Reimbursement System ◽  
Term Care ◽  
South Korean ◽  
Significant Difference

A substantial number of Korean patients who require tracheostomy or oral suctioning are admitted to long-term care hospitals. However, under the Korea’s current daily fixed-rate reimbursement system, the cost of suction catheters is a considerable financial burden. To further discuss proper reimbursement policies for suction catheters in South Korean long-term care system, we examined the number and cost of suction catheters used in a long-term care hospital. This study is a single-center prospective cohort observational study that was conducted on patients admitted to the step-down unit at Ajou University Intermediate Care Hospital. Data of 47 patients were collected for this study. The average amount of suction catheter use per person was 529 during the 62 days of the study period. Daily suction catheter usage showed a statistically significant difference between patients with and without tracheostomy (10.5 ± 6.9 vs 2.1 ± 3.3, p-value < .001). It also showed a significant difference between patients who were diagnosed with or without pneumonia during hospitalization (12.3 ± 4.2 vs 5.5 ± 4.2, p-value < .001). The estimated cost of suction catheter usage for 30 days on a single patient who has tracheostomy was about 160,000 Korean won ($160), which was about 7.3% of the total monthly reimbursement. With the current reimbursement system, there is a potential risk of improper reuse and underuse of suction catheters. To improve respiratory care and prevent pneumonia, we suggest a separate reimbursement system for suction catheters for patients with tracheostomy in South Korean long-term care hospitals.

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals ACUTE MYOCARDIAL INFARCTION;

2013 ◽  
Vol 20 (03) ◽  
pp. 332-340
Author(s):  
ATIF SITWAT HAYAT ◽  
MUHAMMAD ADNAN BAWANY ◽  
JAWAD AHMED QADRI ◽  
Kiran Khalil
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Heart Block ◽  
Complete Heart Block ◽  
Tertiary Care ◽  
Anterior Wall ◽  
P Value ◽  
Inferior Wall ◽  
Care Hospital ◽  
Significant Difference

Background: Ischemic heart disease is the most common cause for complete heart block (CHB) and sudden death. Heartblocks may occur as complications of acute myocardial infarction (AMI) and are associated with increased mortality. The aim of thisstudy is to determine the frequency of complete heart block (CHB) in acute myocardial infarction at a tertiary care hospital. Place andduration: This study was conducted in Cardiology Department of Liaquat University of Medical and Health Sciences from 1st August2009 to 31st January 2010. Study Design: Cross sectional and descriptive study. Materials and Methods: ST segment elevation equal toor more than 1mm (0.1mv) in two of these leads II, III and aVF. Rise in serum creatinine kinase level (CPK Level) more than twice thenormal value along with CK-MB fraction more than 6% of CPK value. Patients with history of chest pain, shortness of breath, nausea,vomiting and unconsciousness were enrolled in the study. The cardiac enzymes tropinin T was also performed at bed side by venousblood sample. Results: Total of 87 patients were included, prevalence of heart blocks was 27.58%. Anterior wall MI was in 50(57.5%)patients. Of these, 13(54.2%) had complete heart block. Inferior wall MI was in 37(42.5%) cases, of these, 11(45.8%) were found withcomplete heart block. There was no significant difference between anterior wall MI and inferior wall MI with complete heart block (P value> 0.05). Mortality was 2.3% with anterior wall MI. Conclusions: Development of complete heart blocks has important prognosticsignificance. Complete heart block was frequent complication of myocardial infarction.

scholarly journals 1442. Effect of Reflex Urine Culturing on Rates of Cultures and Infections in an Acute Care Hospital, Emergency Department, and Two Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S526-S526
Author(s):  
Chelsea Lynch ◽  
Andrea Appleby-Sigler ◽  
Jacqueline Bork ◽  
Rohini Dave ◽  
Kimberly C Claeys ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Long Term Care ◽  
White Blood Cells ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Post Intervention ◽  
Term Care ◽  
Absolute Increase

Abstract Background Urine cultures are often positive in the absence of urinary tract infection (UTI) leading to unnecessary antibiotics. Reflex culturing decreases unnecessary urine culturing in acute care settings but the benefit in other settings is unknown. Methods This was a quasi-experimental study performed at a health system consisting of an acute care hospital, an emergency department (ED), and two long-term care (LTC) facilities. Reflex urine criterion was a urine analysis with > 10 white blood cells/high-power field. Urine cultures performed per 100 bed days of care (BDOC) were compared pre- (August 2016 to July 2017) vs. post-intervention (August 2017 to August 2018) using interrupted time series regression. Catheter-associated UTI (CAUTI) rates were reviewed to determine potential CAUTIs that would have been prevented. Results In acute care, pre-intervention, 894 cultures were performed (3.6 cultures/100 BDOC). Post-intervention, 965 urine cultures were ordered and 507 cultures were performed (1.8 cultures/100 BDOC). Reflex culturing resulted in an immediate 49% decrease in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.8/1000 catheter days and 1.6/1000 catheter days post-intervention. Reflex culturing would have prevented 4/14 CAUTIs. In ED, pre-intervention, 1393 cultures were performed (5.4 cultures/100 visits). Post-intervention, 1959 urine cultures were ordered and 917 were performed (3.3 cultures/100 visits). Reflex culturing resulted in an immediate 47% decrease in cultures performed (P = 0.0015). In LTC, pre-intervention, 257 cultures were performed (0.4 cultures/100 BDOC). Post-intervention, 432 urine cultures were ordered and 354 were performed (0.5 cultures/100 BDOC). Reflex culturing resulted in an immediate 75% increase in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.0/1000 catheter days vs. 1.6/1,000 catheter days post-intervention. Reflex culturing would have prevented 1/13 CAUTIs. Conclusion Reflex culturing canceled 16%-51% of cultures ordered with greatest impact in acute care and the ED and a small absolute increase in LTC. CAUTI rates did not change although reflex culturing would have prevented 29% of CAUTIs in acute care and 8% in LTC. Disclosures All authors: No reported disclosures.

Ecological Study of the Effectiveness of Isolation Precautions in the Management of Hospitalized Patients Colonized or Infected WithAcinetobacter baumannii

2008 ◽  
Vol 29 (12) ◽  
pp. 1118-1123 ◽  
Author(s):  
Houssein Gbaguidi-Haore ◽  
Sophie Legast ◽  
Michelle Thouverez ◽  
Xavier Bertrand ◽  
Daniel Talon
Keyword(s):  
Ecological Study ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Annual Incidence ◽  
University Hospital ◽  
Outcome Variable ◽  
Care Hospital ◽  
Aggregated Data ◽  
The Impact

Objective.To assess the impact of isolation precautions on the incidence of patients colonized or infected withAcinetobacter baumannii(case patients) in a university hospital during the period from 1999 to 2006.Design.Ecological study.Setting.The Besançon University Hospital in France, a 1,200-bed acute care hospital with approximately 50,000 admissions per year.Methods.Using Poisson regression analysis, we evaluated a total of 350,000 patient-days to determine the annual incidence of case patients. This annual incidence was used as the outcome variable, and infection control practices, antibiotic use, and other aggregated data regarding patients' age, sex, McCabe score, and immune status were used as covariates.Results.The implementation of isolation precautions was independently and negatively associated with the incidence of patients colonized or infected withA. baumannii(relative risk, 0.50 [95% confidence interval, 0.40–0.64];P< .001).Conclusions.Our study suggests that the implementation of isolation precautions, in addition to standard precautions, effectively prevents the spread ofA. baumanniiin a hospital setting.

Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

2020 ◽  
pp. 1-9
Author(s):  
Ali Faisal Saleem ◽  
Huma Faiz Halepota ◽  
Hasaan Omar ◽  
Areeba Zain ◽  
Muhammad Arif Mateen Khan
Keyword(s):  
Abdominal Surgery ◽  
Surgical Site Infection ◽  
Tertiary Care ◽  
Stable Condition ◽  
University Hospital ◽  
P Value ◽  
Care Hospital ◽  
Site Infection ◽  
Significant Difference ◽  
Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...  

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